Sec. 12. (a) As used in this chapter, "pharmacy benefit manager" means an entity that, on behalf of a health plan, state agency, insurer, managed care organization, or other third party payor:
(1) contracts directly or indirectly with pharmacies to provide prescription drugs to individuals;
(2) administers a prescription drug benefit;
(3) processes or pays pharmacy claims;
(4) creates or updates prescription drug formularies;
(5) makes or assists in making prior authorization determinations on prescription drugs;
(6) administers rebates on prescription drugs; or
(7) establishes a pharmacy network.
(b) The term does not include the following:
(1) A person licensed under IC 16.
(2) A health provider who is:
(A) described in IC 25-0.5-1; and
(B) licensed or registered under IC 25.
(3) A consultant who only provides advice concerning the selection or performance of a pharmacy benefit manager.
As added by P.L.68-2020, SEC.1. Amended by P.L.32-2021, SEC.77.
Structure Indiana Code
Article 1. Department of Insurance
Chapter 24.5. Pharmacy Benefit Managers
27-1-24.5-1. "Covered Individual"
27-1-24.5-2. "Effective Rate of Reimbursement"
27-1-24.5-3. "Equal Access and Incentives"
27-1-24.5-6. "Independent Pharmacies"
27-1-24.5-7. "Maximum Allowable Cost"
27-1-24.5-8. "Maximum Allowable Cost List"
27-1-24.5-10. "Pharmacist Services"
27-1-24.5-12. "Pharmacy Benefit Manager"
27-1-24.5-13. "Pharmacy Benefit Manager Affiliate"
27-1-24.5-14. "Pharmacy Benefit Manager Network"
27-1-24.5-15. "Pharmacy Services Administrative Organization"
27-1-24.5-19. Equal Access and Incentives; Prohibited Acts
27-1-24.5-19.5. Federal Drug Pricing Program
27-1-24.5-20. Acts of the Commissioner; Confidentiality
27-1-24.5-21. Annual Reporting Requirements; Trade Secrets
27-1-24.5-22. Required Information; Appeals Process; Auditing Procedures
27-1-24.5-22.5. Aggregated Information From Pharmacy Benefit Manager Reports
27-1-24.5-22.6. Filing Complaints With Department of Insurance
27-1-24.5-24. Information Necessary for Appeal
27-1-24.5-25. Party's Right to Audit; Amounts Paid; Consideration
27-1-24.5-26. Disclosure of Contract With Another Party
27-1-24.5-27. Contracts of Pharmacy Services Administrative Organizations
27-1-24.5-27.5. Pharmacist May Not Be Required to Collect Higher Copayment for Prescription Drug